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Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3‐year review
Author(s) -
Thevarajah A.,
Simmons D.
Publication year - 2019
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13962
Subject(s) - medicine , gestational diabetes , odds ratio , retrospective cohort study , pregnancy , gestational age , obstetrics , confidence interval , hypoglycemia , diabetes mellitus , logistic regression , gestation , pediatrics , endocrinology , genetics , biology
Aim To determine risk factors associated with neonatal hypoglycaemia and hyperbilirubinaemia, and assess their impact on neonatal outcomes in pregnancies complicated by gestational diabetes mellitus ( GDM ). Methods Retrospective review investigating all pregnancies complicated by GDM at Campbelltown Hospital (Sydney, Australia) between 1 January 2013 and 31 December 2015. Main outcomes measured were neonatal hypoglycaemia (capillary glucose levels < 1.8 mmol/l) and hyperbilirubinaemia (total serum bilirubin levels greater than age‐appropriate thresholds for phototherapy). Adjusted odds ratios [95% confidence interval ( CI )] are shown, calculated by multivariable logistic regression. Results Some 60 (7.8%) infants developed hypoglycaemia, 58 (7.5%) developed hyperbilirubinaemia and 13 (1.7%) developed both. Risk of developing hypoglycaemia increased 1.8‐fold (95% CI 1.3–2.6, P < 0.001) per gestational week at GDM diagnosis, 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per mmol/l maternal fasting glucose, 6.2‐fold (95% CI 2.6–16.2, P < 0.001) with maternal history of macrosomia, 10.8‐fold (95% CI 4.1–27.6, P < 0.001) with multiple pregnancy and 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per gestational week at birth. Risk of hyperbilirubinaemia increased with multiple pregnancy (26.4; 95% CI 11.7–59.7, P < 0.001), and 1.5‐fold (95% CI 1.1–2.1, P = 0.01) per gestational week at GDM diagnosis. Hypoglycaemia was associated with a 2.8‐fold (95% CI 1.1–7.1, P = 0.03) increased risk of macrosomia, a 5.4‐fold (95% CI 1.1–27.3, P = 0.04) excess risk of shoulder dystocia and a 6.4‐fold increased risk of 5‐min APGAR ≤ 7 (95% CI 1.2–1.7, P < 0.001). Hyperbilirubinaemia was associated with an excess risk of polycythaemia (packed cell volume > 0.6; 97.1, 95% CI 38.9–241.5, P < 0.001). Conclusions Neonatal hypoglycaemia and hyperbilirubinaemia largely occur in different pregnancies. Both are associated with earlier GDM diagnosis; however, hypoglycaemia is more associated with maternal glycaemia and its sequelae, and hyperbilirubinaemia is associated with polycythaemia.